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Womb cancer

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Womb cancer


  


Introduction

Cancer of the womb (uterus) is a common cancer that affects the female reproductive system. It's also called uterine cancer and endometrial cancer.

Abnormal vaginal bleeding is the most common symptom of womb cancer.

If you have been through the menopause, any vaginal bleeding is considered abnormal. If you have not yet been through the menopause, unusual bleeding may include bleeding between your periods.

You should see your GP as soon as possible if you experience any unusual vaginal bleeding. While it's unlikely to be caused by womb cancer, it's best to be sure.

Your GP will examine you and ask about your symptoms. They will refer you to a specialist for further tests if they suspect you may have a serious problem, or if they are unsure about a diagnosis.

 

Types of womb cancer

The vast majority of womb cancers begin in the cells that make up the lining of the womb (called the endometrium), which is why cancer of the womb is often called endometrial cancer.

In rare cases, womb cancer can start in the muscles surrounding the womb. This type of cancer is called uterine sarcoma and may be treated in a different way from endometrial cancer.

This article uses the term womb cancer, and mostly includes information about endometrial cancer. 

Womb cancer is separate from other cancers of the female reproductive system, such as ovarian cancer and cervical cancer.

 

Why does womb cancer happen?

It's not clear exactly what causes womb cancer, but certain things can increase your risk of developing the condition.

A hormone imbalance is one of the most important risks for womb cancer. Specifically, your risk is increased if you have high levels of a hormone called oestrogen in your body.

A number of things can cause this hormone imbalance, including obesity, diabetes, and hormone replacement therapy (HRT). There is also a small increase in the risk of womb cancer with long-term use of the breast cancer drug tamoxifen.

It's not always possible to prevent womb cancer, but some things are thought to reduce your risk. This includes maintaining a healthy weight and the long-term use of some types of contraception.

 

How is womb cancer treated?

The most common treatment for womb cancer is the surgical removal of the womb (hysterectomy).

A hysterectomy can cure womb cancer in its early stages, but you will no longer be able to get pregnant. Surgery for womb cancer is also likely to include the removal of the ovaries and fallopian tubes.

Radiotherapy or chemotherapy are also sometimes used, often in conjunction with surgery.

A type of hormone therapy may be used if you are yet to go through the menopause and would still like to have children.

Even if your cancer is advanced and the chances of a cure are small, treatment can still help to relieve symptoms and prolong your life.

 

Living with womb cancer

Living with cancer is challenging and womb cancer can affect your life in specific ways.

For example, your sex life may be affected if you have a hysterectomy. You may find it physically more difficult to have sex and have a reduced sex drive.

You may find it beneficial to talk to other people about your condition, including family members, your partner, or other people with womb cancer.

 

Who is affected?

Womb cancer is the most commonly occurring cancer of the female reproductive system. It's the fourth most common cancer diagnosed in women after breast cancer, lung cancer, and cancer of the colon and rectum.

In the UK, about 8,475 new cases of womb cancer are diagnosed each year. Womb cancer is more common in women who have been through the menopause, and most cases are diagnosed in women aged 40 to 74.

Womb cancer accounts for about 3% of all cancers diagnosed in women.

 

Symptoms of womb cancer 

The most common symptom of womb cancer is abnormal bleeding from the vagina, although most people with abnormal bleeding don't have cancer.

Bleeding may start as light bleeding accompanied by a watery discharge, which may get heavier over time. Most women diagnosed with womb cancer have been through the menopause, so any vaginal bleeding will be unusual.

In women who haven't been through the menopause, unusual vaginal bleeding may consist of:



periods that are heavier than usual



vaginal bleeding in between normal periods



Less common symptoms include pain in the lower abdomen (tummy) and pain during sex.

If womb cancer reaches a more advanced stage, it may cause additional symptoms. These include:



pain in the back, legs, or pelvis



loss of appetite



tiredness



nausea



 

When to seek medical advice

If you have postmenopausal vaginal bleeding, or notice a change in the normal pattern of your period, visit your GP.

Only 1 in 10 cases of unusual vaginal bleeding after the menopause are caused by womb cancer, so it's unlikely your symptoms will be caused by this condition.

However, if you have unusual vaginal bleeding, it's important to get the cause of your symptoms investigated. The bleeding may be the result of a number of other potentially serious health conditions, such as:



endometriosis – where tissue that behaves like the lining of the womb is found on the outside of the womb



fibroids – non-cancerous growths that can develop inside the uterus



polyps in the womb lining



Other types of gynaecological cancer can also cause unusual vaginal bleeding, particularly cervical cancer.

 

Causes of womb cancer 

It's not known exactly what causes womb cancer, but certain things can increase your risk of developing it.

Cancer begins with a change (mutation) in the structure of the DNA in cells, which can affect how they grow. This means cells grow and reproduce uncontrollably, producing a lump of tissue called a tumour.

If left untreated, cancer can grow and spread to other parts of your body, either directly or through the blood and lymphatic system.

 

Increased risk

A number of things have been identified that increase the risk of developing womb cancer. Some of these are discussed below.

 

Age

The risk of developing womb cancer increases with age. The majority of cases occur in women aged 40 to 74, with only 1% of cases being diagnosed in women under 40.

 

Oestrogen

The risk of developing womb cancer is linked to the body's exposure to oestrogen. Oestrogen is one of the hormones that regulates the reproductive system in women.



oestrogen stimulates the release of eggs from your ovaries and causes the cells of the womb lining to divide



progesterone gets the lining of your uterus ready to receive the egg from the ovaries



The levels of oestrogen and progesterone in your body are usually balanced with each other. If oestrogen isn't kept in balance by progesterone, the level in the body can increase. This is called unopposed oestrogen.

After the menopause, the body stops producing progesterone. However, there are still small amounts of oestrogen being produced. This unopposed oestrogen causes the cells of the endometrium to divide, which can increase the risk of womb cancer.

 

Hormone replacement therapy (HRT)

Because of the link between increased levels of unopposed oestrogen and womb cancer, oestrogen-only hormone replacement therapy (HRT) should only be given to women who have had their womb surgically removed (hysterectomy).

In all other cases, both oestrogen and progesterone (combination HRT) must be used in HRT to reduce the risk of womb cancer.

 

Being overweight or obese

As oestrogen can be produced in fatty tissue, being overweight or obese increases the level of oestrogen in your body. This significantly increases your chances of developing womb cancer.

Women who are overweight are three times more likely to develop womb cancer compared with women who are a healthy weight. Very obese women are six times more likely to develop endometrial cancer compared with women who are a healthy weight.

One way to assess whether your weight is healthy is to calculate your body mass index (BMI). In the UK, people with a BMI of between 25 and 30 are overweight, and those with an index above 30 are obese.

 

Reproductive history

Women who have not had children are at a higher risk of womb cancer. This may be because the increased levels of progesterone and decreased levels of oestrogen that occur during pregnancy have a protective effect on the lining of the womb.

 

Tamoxifen

Women who are treated with tamoxifen (a hormone treatment for breast cancer) can be at an increased risk of developing womb cancer. However, this risk is outweighed by the benefits that tamoxifen provides in preventing breast cancer.

It's important to visit your GP if you're taking tamoxifen and experience any abnormal vaginal bleeding.

 

Diabetes

Women with diabetes are twice as likely to develop womb cancer as women without the condition.

Diabetes causes an increase in the amount of insulin in your body, which in turn can raise your oestrogen levels.

Many women with type 2 diabetes are also overweight, which further increases the risk.

 

Polycystic ovarian syndrome (PCOS)

Women with polycystic ovarian syndrome (PCOS) are at a higher risk of developing womb cancer, as they have high levels of oestrogen in their bodies.

Women with PCOS have multiple cysts in the ovary, which can cause symptoms such as irregular or light periods, or no periods at all, as well as problems getting pregnant, weight gain, acne, and excessive hair growth (hirsutism).

 

Endometrial hyperplasia

Endometrial hyperplasia is when the lining of the womb becomes thicker. Women with the condition may be at an increased risk of developing womb cancer.

 

 

Diagnosing womb cancer 

You should visit your GP if you have abnormal vaginal bleeding. While it's unlikely to be caused by womb cancer, it's best to be sure.

Your GP will probably carry out a physical examination of your pelvic area, including your vagina, womb, ovaries, and bladder. They will ask about your symptoms, when they happen, and how often.

You may be referred to a specialist in conditions of the female reproductive organs (a gynaecologist) for further tests. Some of these tests are outlined below.

 

Transvaginal ultrasound (TVU)

Another test you may have is called a transvaginal ultrasound (TVU). TVU is a type of ultrasound scan that uses a small scanner in the form of a probe.

This is placed directly into the vagina to obtain a detailed picture of the inside of the uterus. The probe can feel a little uncomfortable, but shouldn't be painful.

The TVU checks whether there are any changes to the thickness of the lining of your uterus that could be caused by the presence of cancerous cells.

 

Biopsy

If the results of the TVU detect changes in the thickness of the lining of the uterus, you will usually have a biopsy to confirm the diagnosis.

In a biopsy, a small sample of cells is taken from the lining of the womb (the endometrium). The sample is then checked at a laboratory for the presence of cancerous cells.

The biopsy can be carried out in several ways, including:



aspiration biopsy – a small flexible tube is inserted into your vagina and up into your womb, and then sucks up a small sample of cells



hysteroscopy – this allows the doctor to look at the inside of the womb using a thin type of telescope called a hysteroscope, which is inserted through your vagina and into your womb, allowing the doctor to look at the lining of the womb and take a sample from it



In some cases, a hysteroscopy may be used before dilatation and curettage (D&C). D&C is a minor surgical procedure carried out under general anaesthetic, where some tissue from the womb lining is removed. The tissue is then sent off to a laboratory for further testing.

 

Blood test

A blood test can sometimes help diagnose womb cancer. This is because some cancerous tumours release certain chemicals into your blood, known as tumour markers, which can be detected during a blood test.

However, this type of test isn't very reliable. The presence of these chemicals doesn't mean you definitely have womb cancer. Some people with womb cancer don't have these chemicals in their blood.

 

 

Tests if you have womb cancer

If you're diagnosed with womb cancer, you may have further tests to help determine the stage of the cancer. Staging the cancer will allow the doctors to work out how large the cancer is, whether or not it has spread, and the best treatment options for you.

These tests may include:



a chest X-ray – where radiation is used to check if the cancer has spread to the lungs



magnetic resonance imaging (MRI) – where magnetic fields are used to create a detailed image of the inside of your body to check if the cancer has spread



a computerised tomography (CT) scan – where a series of X-rays are used to create a detailed image of the inside of your body to check if the cancer has spread



further blood tests – these are usually done to check your general health and how well some of your organs are functioning



 

 

Treating womb cancer 

Surgery is the main treatment for womb cancer, although different methods can be used depending on your personal circumstances.

 

Cancer treatment team 

People with cancer should be cared for by a team of specialists who work together to provide the best treatment and care. This is called a multidisciplinary team (MDT).

The team will consist of specialist cancer surgeons (gynaecological oncologists), a clinical oncologist (a specialist in radiotherapy treatment), a medical oncologist (a chemotherapy specialist), and a specialist nurse.

Other members will include a radiologist and pathologist. Specialists in supportive care, such as a palliative care physician and specialist palliative care nurses, may also be involved, as well as a dietitian, a physiotherapist, and an occupational therapist.

When deciding which treatment is best for you, your doctors will consider:



the stage of your cancer (how big it is and how far it has spread)



your general health



whether fertility is a matter of concern (this is rare because of the age at which womb cancer usually occurs)



Your MDT will recommend the best treatment for you based on these considerations, but the final decision is yours.

Before going to hospital to discuss your treatment options, it can be useful to write a list of questions you'd like to ask the specialist. For example, you may want to find out what the advantages and disadvantages of particular treatments are.

The stages of womb cancer and the main treatment options are outlined below.

 

Stages of womb cancer hide

Health professionals use a staging system to describe how far womb cancer has advanced. These stages are:



stage 1 – the cancer is still contained inside the womb (uterus)



stage 2 – the cancer has spread to the neck of the womb (the cervix)



stage 3 – the cancer has spread outside the womb into nearby tissues in the pelvis or the lymph nodes



stage 4 – the cancer has spread to the soft tissues of the abdomen, or into other organs, such as the bladder, bowel, liver, or lungs



Your chances of surviving womb cancer depend on the stage at which it's diagnosed.

If womb cancer is diagnosed at stage 1, the outlook is good and around 95% of women live for at least five more years. Many women with stage 1 womb cancer are cured.

If womb cancer is diagnosed at stage 2, you have around a 77% chance of living at least five more years.

If the condition is diagnosed at stage 3, you have a 40% chance of living at least another five years.

Around one in four womb cancers are diagnosed at stage 4. By this point, you only have a 15% chance of living at least five more years.

 

Living with womb cancer 

A diagnosis of cancer is a challenge for most people. How cancer affects your daily life depends on the stage of your cancer and the treatments used.

There are many ways to get help coping with cancer. Not all of them work for everybody, but one or more should prove helpful:



keep talking to your friends and family – they can be a powerful support system



communicate with others in the same situation



learn about your condition



set reasonable goals



take time out for yourself



 

 

After treatment hide

Women with womb cancer usually have a hysterectomy. This can be a major operation, and recovery may take from 6 to 12 weeks.

During this time you will have to avoid lifting things (for example, children and heavy shopping bags) and doing heavy housework. You won't be able to drive for between three and eight weeks after the operation.

Most women need 4 to 12 weeks off work after a hysterectomy. The recovery time will depend on the type of surgery you have, whether or not any problems develop, and what type of work you will return to.

Some of the treatments for endometrial cancer, particularly radiotherapy, can make you very tired. You may need to take a break from some of your normal activities for a while. Don't be afraid to ask for practical help from family and friends if you need it.

 

Follow-up

After your course of treatment has finished, you'll probably be invited back for regular check-ups. At the check-up, your doctor will examine you (this is likely to include an internal examination) and possibly carry out blood tests or scans to see how your cancer is responding to treatment.

 

 

Preventing womb cancer 

It's not always possible to prevent womb cancer, but some things are believed to reduce the risk of the condition.

 

Healthy weight, diet and exercise

The most effective way of preventing womb cancer is to maintain a healthy weight.

The best way to avoid becoming overweight or obese is to eat healthily and exercise regularly. A low-fat, high-fibre diet is recommended, including wholegrains and at least five portions a day of fresh fruit and vegetables.

For most people, a total of at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity such as cycling or fast walking every week is recommended. Ideally, this should be spread across the week into at least five separate periods.

If you haven't exercised before or haven't done any for some time, see your GP for a health check-up before you start a new exercise programme.

 

Contraception

Research has also shown that long-term use of the combined contraceptive pill (the pill) can lower the risk of womb cancer.

Other types of contraception, such as contraceptive implants and the intrauterine system (IUS), work by releasing progestogen (a synthetic version of progesterone). These may also reduce the risk of womb cancer.



Womb cancer